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Patient Info
 

PLEASE BRING A CURRENT LIST OF ALL MEDICATIONS TO EVERY VISIT!

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Form A - New Patient Paperwork Form A - New Patient Paperwork

If you are a new patient, please download and complete these forms prior to visiting our office.


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Form B - Medical Records Release Form B - Medical Records Release

Medical Records Release. 

Please note:  There may be a charge associated with obtaining your medical records.  Please call 919.881.0160 with any questions.


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Form C - Nuclear Instructions Form C - Nuclear Instructions
Nuclear Stress Test Instructions

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Form D - Referral Form Form D - Referral Form
Referral Form. Please fill out all information and fax to 919-881-0887. We will contact your patient to set up an appointment time and alert you once the appointment time is confirmed. We thank you for your trust in caring for your patients.
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Form E - Notice of Privacy Policies Form E - Notice of Privacy Policies
Capital Heart Associates Privacy Policies
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Form F - Raleigh/Lake Boone Trail Directions Form F - Raleigh/Lake Boone Trail Directions
Directions to Raleigh office - 4201 Lake Boone Trail, Suite 104, Raleigh, NC 27607.  919-881-0160

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Form G - Dr. Emery Records Transfer Form G - Dr. Emery Records Transfer

Please print this form to transfer your records from WakeMed/Carolina Cardiology to our office. This is for Dr. Emery patients only.

Fax this form to 919-350-7985 or mail it to: WakeMed, 3000 New Bern Avenue, Raleigh, NC 27610, Attn: HIM Dept - ROI


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